Real-World Effect of Anti-VEGF Drugs on IOP
Ophthalmology, May 2018
In a review of IRIS Registry data, Atchison et al. looked at intraocular pressure (IOP) in eyes treated with an anti–vascular endothelial growth factor (anti-VEGF) agent and compared that with IOP levels in untreated fellow eyes. They found that treatment generally resulted in a small but significant decrease in IOP; however, some treated eyes had substantial elevation of IOP.
For their study, the authors identified 23,776 patients who received at least 12 injections of a single anti-VEGF drug (aflibercept, bevacizumab, or ranibizumab) in their right eye. Left eyes were not treated. Diagnoses were neovascular age-related macular degeneration (AMD) only (73%), diabetic macular edema only (12%), vein occlusion with macular edema (11%), and a combination of these conditions (4%). The minimum follow-up period was 1 year.
Primary outcome measures were IOP change from baseline and the proportion of eyes with a clinically significant increase in IOP, defined as a sustained increase of at least 6 mm Hg resulting in IOP > 21 mm Hg. Subgroup analyses were conducted among patients with AMD only and patients who did not have anti-VEGF treatment in the year before study entry.
Mean IOP declined from baseline to ≥ 1 year in all treatment arms, including subsets. Overall, the mean decrease was 0.9 mm Hg for treated eyes and 0.2 mm Hg for untreated eyes. A generalized linear model accounting for confounders showed that, in most groups, the degree of IOP lowering was less with bevacizumab than with aflibercept or ranibizumab.
Clinically significant increases in IOP were sustained in 2.6% of treated eyes and 1.5% of untreated eyes; the rates by treatment were 1.9% for aflibercept, 2.8% for bevacizumab, and 2.8% for ranibizumab. The increases in untreated eyes were significantly lower than in eyes treated with bevacizumab and ranibizumab, but not with aflibercept. The reason for this difference is unclear and requires further investigation. Aflibercept is the only drug in this study with affinity for placental growth factor, which could affect the trabecular meshwork in a manner that is not yet known.
The original article can be found here.